摘要
目的探讨促性腺激素释放激素激动剂(GnRH-a)长方案促排卵并鲜胚移植后临床妊娠结局的影响因素,构建临床妊娠的列线图预测模型,并验证模型。方法纳入2019年1月—2023年4月于兰州大学第一医院生殖医学中心行GnRH-a长方案促排卵并鲜胚移植共4627个周期的临床资料,统计分析纳入患者的一般临床资料、临床妊娠结局。采用最小绝对收缩和选择算子(LASSO)回归技术和多因素Logistic回归筛选数据维度和预测因子,按照7∶3的比例将最终纳入的3470个周期随机分配为训练集(2429个)和测试集(1041个)。采用多因素Logistic回归分析建立临床妊娠结局的预测模型并用列线图将其可视化。采用曲线下面积(AUC)、Hosmer-Lemeshow拟合优度检验和决策曲线分析(DCA)评估模型。结果根据LASSO回归分析计算选择18个非零系数变量,多因素Logistic回归分析结果显示年龄、多囊卵巢综合征、反复妊娠丢失、高血压家族史、促性腺激素启动日剂量、扳机用药、扳机日孕酮水平、扳机日子宫内膜厚度、移植胚胎数量、移植优质胚胎数量、移植胚胎类型(囊胚与否)和男方弱精子症患病与否共12个因素作为预测因子建立Logistic模型并用列线图可视化;训练集AUC为0.657,验证集AUC为0.617,Hosmer-Lemeshow检验显示该模型拟合好(P=0.208,平均绝对误差=0.008),DCA提示当患者临床妊娠的阈值概率在11%~67%时,应用该列线图可增加净获益。结论该模型可为GnRH-a长方案促排卵并鲜胚移植周期临床妊娠结局预测提供参考,但该模型的预测精度有限,有待于进一步开发。
Objective To discuss the influencing factors of clinical pregnancy outcome in patients undergoing fresh embryo transfer by the use of Gonadotrophin releasing hormone-agonists(GnRH-a)long protocol,construct a prediction model of clinical pregnancy according to those factors,and then verify the model.Methods A total of 4627 cycles of fresh embryo transfer by the use of GnRH-a long protocol from January 2019 to April 2023 were performed in the Reproductive Medicine Center of the First Hospital of Lanzhou University.After excluding the relevant cycles according to the exclusion criteria,general clinical data and pregnancy outcomes of the included patients were statistically analyzed according to the data type.The least absolute shrinkage and selection operator(LASSO)regression technique and multivariate logistic regression analysis were used to select data dimensions and predictors.The 3740 cycles included were randomly assigned to the training set(n=2429)and test set(n=1041)according to the ratio of 7∶3.Multivariate logistic regression analysis was used to establish a predictive model and nomogram for pregnancy outcome of fresh embryo transfer.The model was evaluated by calculating the area under the curve(AUC),Hosmer-Lemeshow test and decision curve analysis(DCA).Results According to the non-zero coefficient calculated by LASSO regression analysis,18 variables were selected for further multivariate logistic regression analysis.Ten factors including female age,family history of hypertension,polycystic ovary syndrome(PCOS),recurrent pregnancy loss(RPL),daily dose of gonadotropin(Gn),trigger protocol,progesterone(P)level on the trigger day,number of embryos transferred,number of high-quality embryos transferred,embryo type(blastocyst or not),endo-metrial thickness on the trigger day and asthenospermia were used as predictors to establish the model,as displayed by the nomogram.The AUC of the training set was 0.657,and the AUC of the validation set was 0.617.The Hosmer-Lemeshow goodness-of-fit test results showed that the model fitted well(Mean absolute error=0.008).DCA suggested that when the threshold probability of clinical pregnancy in patients with fresh embryo transfer was between 15%and 70%,the application of this nomogram could increase the net income.Conclusion This model can provide a reference for the prediction of clinical pregnancy outcomes in fresh embryo transfer by the use of GnRH-a long protocol cycles.However,the prediction accuracy of this study is limited,and more effective prediction models need to be developed in the future.
作者
李宁
何晓霞
张学红
Li Ning;He Xiaoxia;Zhang Xuehong(The First Clinical Medicial School,Lanzhou University,Lanzhou 730000,China;Reproductive Medicine Center,The First Hospital of Lanzhou University,Lanzhou 730000,China)
出处
《兰州大学学报（医学版）》
2024年第8期40-47,共8页
Journal of Lanzhou University（Medical Sciences）
基金
甘肃省卫生健康行业科研计划资助项目(GSWSKY2021-029)。
